Coding is the process of accounting for what we do .. so that we can get reimbursed for it. Car mechanics have the flat rate manual that tells them what to charge us. In medicine, there are similar, but more complicated methods of accounting for what we do. One of the most complex is coding for obstetric services — especially when the family physician is not the one who ultimately does the delivery — as is the case of a c-section done by an obstetric colleague. We had another such episode this week, and it reminded me that coordination of the billing is important. Not only do we family physicians need to communicate closely with our obstetrician colleagues closely regarding the care of the patient, but we need to coordinate our billing as well. AAFP publishes these guidelines … and there are many others ..
The key is that most insurers expect to pay for the delivery. So I spend 14 hrs at the hospital and I deliver the baby .. the reimbursement is the same as if I spend 5 minutes. Nor like the car mechanics .. but it usually works out OK .. unless my patient needs a c-section. In this case, the obstetrician bills for the (operative) delivery and I bill for my time .. or at least I attempt to. I can also bill for assisting with the c-section .. in which case I can't bill for the time associated with the (attempted) vaginal delivery.
Very complicated stuff .. and certainly nothing that I ever wanted to learn in medical school.
The Washington Post picked this one up .. as did many other papers. The reports are based on a paper that was publised today in JAMA based on National Ambulatory Medical Survey data. Bottom line: physicians are beginning to write fewer antiobiotic prescriptions. Cool.
Ouch. My Compaq Armada M700 is very ill. I had to do surgery tonight to see if I could save it .. and I think that I know what to replace. It needs a transplant. Maybe that will help. I spent four hours doing the surgery to take it apart .. but it only took about 30 minutes putting it back together. not bad .. eh? And I didn't have any leftover screws!
This is a nice set of slides that can serve as a patient handout — or speaking points for a short lecture on antibiotcs and antibiotic overuse.
This article in Family Practice Management highlights the need for physicians to create an equitable call schedule. Of course Oncalls.com was built to support such a mechanism. In fact, I think our software is the only one to do so. I guess it's time to start marketing the software .. but … oddly .. people are actually using it .. AND sending us money. It's the 'field of dreams' method: no marketing .. just build it and they will come.
It's been over a week since I posted last. Will try to get here more often. Sorry. Last week was full of patient care (of course) and finishing the application for a grant to help build a digital library of family medicine resources. While I'vebeen involved in grants before, this was my first experience as the primary author of a grant.
Today's medical interest:
Saw a 40ish man who runs a lot … looks like he may have a fibular stres fracture. How to diagnose this? Well … there's a guideline on appropriate work-up of stress fractures, and clearly the recommendation is that after at least one .. but perhaps two negative x-rays … MRI is the best modaility. I ordered x-ray #2 yessterday, and tried to set up MRI, but the patient's insurance refuses to let a primary care physician order and MRI. Wow. Will refer to ortho.